Exposure to gender-based violence and the risk of hypertension, obesity, and anemia: a multilevel analysis of the 2017 Tajikistan demographic and health survey.

Background: Gender-based violence (GBV), including physical violence (PV), sexual violence (SV), and emotional violence (EV) in women, may influence both their physical and psychological health. Prior studies suggest a potential link between these forms of GBV and chronic health conditions, yet evidence remains inconsistent, particularly in low-resource settings. This study investigates the associations between PV, SV, and EV and the risk of hypertension, obesity, and anemia in Tajik women.

Methods: Using data from the 2017 Tajikistan Demographic and Health Survey (TjDHS), 3,620 women aged 15-49 were analyzed. Outcome variables included hypertension (systolic pressure ≥ 140 mmHg or diastolic pressure ≥ 90 mmHg), obesity (BMI ≥ 27.5 kg/m²), and anemia (blood hemoglobin < 12 g/dl), classified based on WHO guidelines. Exposure variables included PV, SV, and EV, assessed using the Conflict Tactics Scale and categorized by severity scores and intensity levels. Multilevel-adjusted linear and logistic regression models were performed.

Results: The mean age of the participants was 32.64 ± 8.52 years. The prevalence of lifetime exposure to overall GBV, PV, SV, and EV was 32.1%, 26.9%, 1.7%, and 15.3%, respectively. The prevalence of hypertension, obesity, and anemia was 10.2%, 27.2%, and 44.0%, respectively. Lifetime exposure to EV was significantly associated with increased odds of obesity (OR, 95% CI: 1.27, 1.04-1.54), whereas moderate-intensity EV exposure was inversely associated with anemia (OR, 95% CI: 0.75, 0.56-0.98). Higher PV severity scores were linked to lower systolic (β, 95% CI: -0.53, -0.72 to -0.34) and diastolic blood pressure (β, 95% CI: -0.17, -0.31 to -0.04). Women in the poorest wealth quintiles, with no education, those who smoke, the unemployed, and those with husbands/partners who consume alcohol were significantly at an increased risk of GBV.

Conclusion: Of the three types of GBV, EV demonstrated a substantial association with obesity and anemia, with differential impacts based on the intensity level. PV severity scores showed an inverse relationship with blood pressure. The findings suggest that EV might be a significant independent risk factor for obesity. Therefore, prioritizing EV in integrated interventions addressing both GBV prevention and chronic conditions is crucial for improving women's health outcomes.

Clinical trial number: Not applicable.